经颈静脉肝内门腔分流术治疗复杂型Budd-Chiari综合征

目的　探讨和评价经颈静脉肝内门腔静脉分流术（TIPS）治疗复杂型Budd-Chiari综合征（BCS）并门脉高压的临床应用价值。方法　患者男4例，女1例，平均年龄33岁，均有不同程度的食管胃底静脉曲张，4例有上消化道出血史，2例伴有腹水。经下腔静脉相当于右肝静脉开口部进针穿刺门脉行TIPS治疗。结果　5例均获成功。门脉压力由术前平均（4.7±1.3）kPa降至（3.5±1.5）kPa（1kPa=7.5mmHg）。术后24h1例死于心肺衰竭；术后3周1例死于肝功能衰竭。另3例平均随访64个月，肝功能均正常。2例于术后6、9个月均有分流道狭窄，并行二次介入治疗。结论　TIPS是解决复杂型BCS伴门脉高压的一种安全有效的治疗方法。

TIPS treatment for complicated Budd-Chiari syndrome

Objective　 To discuss the feasibility of TIPS in the treatment of complicated Budd-Chiari syndrome(BCS) and to evaluate its clinical effect. Methods　Five patients (male/female=4/1) aged from 30 to 35(mean 33 years). Four of 5 patients with varied degree of esophago-gastric varies had the history of upper gastrointestinal bleeding and two had obvious ascites. We punctured the stenotic or occluded hepatic vein into the branch of portal vein in liver parenchyma. Balloon catheter expanding and installing were followed by the gastric coronary vein embolization. Results　Successful operation were obtained in all 5 patients. The mean portal vein pressure dropped from(4.7±1.3)kPa before operation to(3.5±1.5)kPa after TIPS. One patient died in 24 hours after an emergency TIPS. One patient died of liver function failure three weeks later. In the mean 64 months′ follow-up, 2 of the remaining 3 patients received angiography examination and were demonstrated stenosis at the end of hepatic vein. Both patients were treated with re-intervention successfully. Conclusion　TIPS was a safe, effective, and feasible method in the treatment of patients with complicated BCS with portal hypertension.